尿动力学检查在前列腺网状支架治疗中的应用研究
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摘要
为了探讨尿动力学检查在前列腺网状支架治疗中的价值，探讨前列腺网状支架治疗前后支架及后尿道形态变化的规律，进一步提高支架治疗的准确性。选择35例前列腺增生引起的尿潴留的老年病人进行支架治疗，他们由于各种其他疾病而不能耐受开放手术和TURP术，治疗前后分别进行尿动力学检查。结果：所有病人有膀胱出口梗阻(BOO)的存在，24例逼尿肌功能正常或高于正常，11例逼尿肌无力。根据尿道压分布测得后尿道长为5.36±0.91cm，选择支架长为3.33±0.66cm。支架治疗后测得后尿道长为5.97±0.97cm，支架长变为4.14±0.74cm，比术前均有延长。支架治疗成功后测得支架远端离尿道外括约肌间的距离为2.00±0.80cm。根据B超测得的前列腺尿道长来选择支架的正确率为80.1％，结合尿道压测定选择支架的正确率为97.3％。结论：尿动力学检查可以明确支架治疗的适应征；可以提高支架长度选择的正确性；术后检查可以确定支架在后尿道中的位置，明确支架及后尿道形态变化的特点，我们也可以知道支架治疗失败的原因。
To evaluate the value of the urodynamics in the bladder outlet obstruction (BOO) treated with wallstent, to probe the shifty orderliness of stent and posterior urethral before and after the stent implantation , in order to increase the accuracy of stent implantation . We chose 35 old patients with urinary retention caused by benign prostatic hyperplasia (BPH) or prostatic cancer (Pca) , they couldn't bear the open operation or TURP because of the other diseases . Urodynamics performed before and after the wallstent implantation . Results: All the patients had BOO and were fit for implanting wallstent, the function of bladder detrusor was normal or hyper in 24 patients ; the function of bladder detrusor was acontractile in 11 patients .The length of posterior urethral measured by the urethral pressure was 5.36±0.9lem before implantation , the length of wallstent we choosed was 3.33 ±0.66cm . The length of posterior urethral was 5.97±0.97cm after implantation , the length of wallstent was changed to 4.14 ± 0.7
4 cm , they all prolonged after the treatment . the length of stent to outer urethral constrictor was 2.00 ± 0.80cm after satisfied implantation .The correct rate of choosing stent was 80.1% according to the length of prostate measured by transrectal ultrasound , the correct rate was 97.3% when we combined with urethral pressure . conclusion : Urodynamics could tell us the stent implanted indication , could improve the correctness of choosing stent;
After implantation , urodynamics could determine the stent location in the posterior urethral, we could understand the shifty orderliness of stent and posterior urethral, and we also knew the reason why we were fail in stent treatment.
To evaluate the value of the urodynamics in the bladder outlet obstruction (BOO) treated with wallstent, to probe the shifty orderliness of stent and posterior urethral before and after the stent implantation , in order to increase the accuracy of stent implantation . We chose 35 old patients with urinary retention caused by benign prostatic hyperplasia (BPH) or prostatic cancer (Pca) , they couldn't bear the open operation or TURP because of the other diseases . Urodynamics performed before and after the wallstent implantation . Results: All the patients had BOO and were fit for implanting wallstent, the function of bladder detrusor was normal or hyper in 24 patients ; the function of bladder detrusor was acontractile in 11 patients .The length of posterior urethral measured by the urethral pressure was 5.36±0.9lem before implantation , the length of wallstent we choosed was 3.33 ±0.66cm . The length of posterior urethral was 5.97±0.97cm after implantation , the length of wallstent was changed to 4.14 ± 0.7
4 cm , they all prolonged after the treatment . the length of stent to outer urethral constrictor was 2.00 ± 0.80cm after satisfied implantation .The correct rate of choosing stent was 80.1% according to the length of prostate measured by transrectal ultrasound , the correct rate was 97.3% when we combined with urethral pressure . conclusion : Urodynamics could tell us the stent implanted indication , could improve the correctness of choosing stent;
After implantation , urodynamics could determine the stent location in the posterior urethral, we could understand the shifty orderliness of stent and posterior urethral, and we also knew the reason why we were fail in stent treatment.
引文
1．那彦群，郝金瑞，刘重禄，等。形状记忆合金网状支架治疗前列腺增生症。中华泌尿外科杂志，199616：354-356。
2. Fabin KM. Der introprostatische "Partielle Katheter"(Urologische Spirale).Urol, 1980,19,236.
3. Chapple CR, Milroy EJG,Richards D.Permanently implanted urethral stent for prostatic obstruction in the unfitpatient:preliminary report. Br J Urol, 1990,66:58-65.
4．李炎唐，主编．泌尿外科高科技．北京：军事科学出版社，1998，143．
5．周芳坚，谢晋良，申鹏飞，等，尿动力学检查在处理前列腺增生症中的意义．中华泌尿外科杂．1998，19：271-273．
6. Desmond A D,Ramuyya GR.The adaptation urethral pressure profiles to detect sphincter incopetence and sphincter obstruction using a microcomputer. J Urol. 1987,137:457-460.
7. Gotoh M,Yoshikawa Y, Konda AS,et al,Prognostic value of pressure-flow study in surgical treatment of benign prostatic obstruction. World J Urol. 1999,17(5):274-278
8. Schafer W.Urodynamics in benign prostatic hyperplasia. Arch Ital Urol Androl 1993,65(6):599-613.
9．廖利民，石炳毅，梁春泉，等，P-Q图及A-G图诊断前列腺增生性膀胱出口梗阻．中华泌尿科杂志，1996，17：746-748
10．王东文，刘红耀，米振国，等，前列腺增生症的逼尿肌功能改变．中华泌尿外科杂志，1998，19：268-270
11．Paul Abrams，主译张小东．Urodymamics．尿动力学．北京：人民卫生出版社，1999，150-169．
12．陆洪兵，张顺兴，陈向东，等，前列腺增生伴逼尿肌无力的电切术治疗。临床泌尿外科杂志，2002，17：117-118。
13．经浩，车文俊，冯秋云，等，术中超声监视尿道内置入镍钛形状记忆合金网状支架治疗前列腺增生症的临床研究。中国超声医学杂志，1997，13：51-53。
14．张文鼎，唐涌志，丁满棠，等，镍钛记忆合金网状支架在BPH患者的应用及远期疗效观察。临床泌尿外科杂志，2001，16：3-5。
2. Fabin KM. Der introprostatische "Partielle Katheter"(Urologische Spirale).Urol, 1980,19,236.
3. Chapple CR, Milroy EJG,Richards D.Permanently implanted urethral stent for prostatic obstruction in the unfitpatient:preliminary report. Br J Urol, 1990,66:58-65.
4．李炎唐，主编．泌尿外科高科技．北京：军事科学出版社，1998，143．
5．周芳坚，谢晋良，申鹏飞，等，尿动力学检查在处理前列腺增生症中的意义．中华泌尿外科杂．1998，19：271-273．
6. Desmond A D,Ramuyya GR.The adaptation urethral pressure profiles to detect sphincter incopetence and sphincter obstruction using a microcomputer. J Urol. 1987,137:457-460.
7. Gotoh M,Yoshikawa Y, Konda AS,et al,Prognostic value of pressure-flow study in surgical treatment of benign prostatic obstruction. World J Urol. 1999,17(5):274-278
8. Schafer W.Urodynamics in benign prostatic hyperplasia. Arch Ital Urol Androl 1993,65(6):599-613.
9．廖利民，石炳毅，梁春泉，等，P-Q图及A-G图诊断前列腺增生性膀胱出口梗阻．中华泌尿科杂志，1996，17：746-748
10．王东文，刘红耀，米振国，等，前列腺增生症的逼尿肌功能改变．中华泌尿外科杂志，1998，19：268-270
11．Paul Abrams，主译张小东．Urodymamics．尿动力学．北京：人民卫生出版社，1999，150-169．
12．陆洪兵，张顺兴，陈向东，等，前列腺增生伴逼尿肌无力的电切术治疗。临床泌尿外科杂志，2002，17：117-118。
13．经浩，车文俊，冯秋云，等，术中超声监视尿道内置入镍钛形状记忆合金网状支架治疗前列腺增生症的临床研究。中国超声医学杂志，1997，13：51-53。
14．张文鼎，唐涌志，丁满棠，等，镍钛记忆合金网状支架在BPH患者的应用及远期疗效观察。临床泌尿外科杂志，2001，16：3-5。